This study aimed to evaluate the relationship between magnesium (Mg) status, serum vitamin D (VD) concentration and mortality in congestive heart failure (CHF) patients. Data for this study were extracted from the National Health and Nutrition Examination Surveys 2007-2018. Magnesium depletion score (MDS) is a scoring system developed to predict the status of Mg deficiency that considers the pathophysiological factors influencing the reabsorption capability of the kidneys. The primary outcome was all-cause mortality of CHF patients and the secondary outcome was mortality due to cardiovascular disease (CVD). Weighted univariate and multivariate cox proportional hazards models were used to explore the association between Mg status, serum VD concentration and all-cause mortality or mortality due to CVD in CHF patients, using hazard ratios (HRs) and 95 % confidence intervals (CIs). Subgroup analyses based on age, physical activity (PA), course of CHF, race, and body mass index were further assessed with regards to the association analysis. In total, 1022 CHF patients were included, of whom 418 (40.90 %) died by 31st December 2019. After adjusting for all covariates, high MDS (>2 points) was related to a higher risk of all-cause mortality (HR = 1.72, 95 % CI: 1.30-2.29) and mortality due to CVD (HR = 1.71, 95 % CI: 1.29-2.25); a higher serum VD concentration was related to a lower risk of all-cause mortality (HR = 0.78, 95 %CI: 0.62-0.99) and mortality due to CVD (HR = 0.80, 95 % CI: 0.63-0.99). Compared to patients with high serum VD concentration and low MDS, patients with low serum VD concentration and high MDS had a high risk of all-cause mortality (HR = 2.44, 95 % CI: 1.54-3.85, p for trend = 0.043) and mortality due to CVD (HR = 2.41, 95 % CI: 1.32-4.40). Serum VD and Mg status may have a combined effect in improving the prognosis in CHF patients, thus an appropriate level of serum VD and Mg intake may be beneficial to maintain cardiovascular health, thereby improving outcome.

Olfactory impairment in the elderly has been shown to be associated with an increased risk of cognitive decline, and oxidative stress may be involved in this process. Dietary magnesium (Mg), as an antioxidant dietary nutrient, has been reported to be associated with cognitive decline. This study aimed to explore the effect of dietary Mg intake on cognitive decline related to olfactory impairment in older adults. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) database 2013-2014. Information on dietary Mg intake was obtained from 24-hour interview. Assessment of cognitive decline included four evaluation dimensions: the Consortium to Establish a Registry for Alzheimer's Disease (including immediate and delayed), an animal fluency test, and a digit symbol substitution test. Weighted univariable and multivariable linear regression models were utilized to explore the effect of Mg on cognitive decline related to olfactory impairment, using β values and 95% confidence intervals (CIs). Subgroup analyses based on gender, history of diabetes, cardiovascular disease (CVD) and depression were further assessed. In total, 1,388 elderly people were included, of whom 319 (22.98%) had olfactory impairment. After adjusting for all covariates, there was an inverse relationship between high Mg intake and cognitive decline (β=-0.21, 95%CI: -0.37 to -0.04), and olfactory impairment was positively associated with cognitive decline (β=0.53, 95%CI: 0.28 to 0.77). Among the elderly with olfactory impairment, the odds of cognitive decline were reduced in the high Mg intake group (β=0.37, 95% CI: 0.04 to 0.71) compared to the low Mg intake group (β=0.67, 95%CI: 0.39 to 0.96), especially among the elderly who were female (β=0.53, 95% CI: 0.09 to 0.98), with diabetes (β=0.72, 95% CI: 0.46 to 0.99), and without CVD (β=0.33, 95% CI: 0.05 to 0.61) and depression (β=0.38, 95% CI: 0.06 to 0.70). Adequate dietary Mg intake may provide potential beneficial effects, improving cognitive function, among elderly patients with olfactory impairment, which should be confirmed by scale-large prospective studies.

This prospective case-control study explored the association between urinary magnesium levels and acute urinary retention (AUR) in individuals presenting to the emergency department. Forty-six participants, comprising 23 cases and 23 age- and sex-matched controls, underwent urine analysis for magnesium, calcium, and creatinine concentrations. The exclusion criteria mitigated potential confounding factors. AUR cases exhibited significantly lower magnesium (5.97 vs.3.87, p = 0.031), calcium (11.04 vs. 5.3, p = 0.022), and creatinine (149.9 vs. 66.0, p = 0.005) levels (mg/dL) compared to controls. After adjusting for creatinine levels, no intergroup differences were observed. An inverse linear correlation was noted between the International Prostate Symptom Score and magnesium level (R2 = 0.15, p = 0.009). A magnesium cut-off of 3.57 mg/dL demonstrated 82.6 % sensitivity, 56.5 % specificity, and an AUC of 0.70. Patients with magnesium levels below 3.57 mg/dL had an 80 % higher risk of AUR (OR: 1.80, 95 % CI: 1.08-3.01, p = 0.016). This study highlights urinary magnesium as a potential marker for risk of AUR, paving the way for larger prospective studies in this intriguing domain. Future interventions that manipulate magnesium levels may offer innovative avenues for managing lower urinary tract disorders.

This study aimed to investigate the association between dietary magnesium intake and all-cause mortality among diabetic retinopathy (DR) patients. In this retrospective cohort study, data of 1,034 DR patients were extracted from the National Health and Nutrition Examination Survey (NHANES) (1999-2018). Dietary magnesium data were obtained from two 24-hour dietary recall interviews, and categorized into quartiles. Potential confounders were selected using weighted univariate Cox regression models. Weighted univariate and multivariate Cox regression models were used to explore the association between dietary magnesium intake and all-cause mortality in DR patients. The results were presented with hazard ratios (HRs) and 95% confidence intervals (CIs). Associations were further explored for subgroups related to age, gender, cardiovascular disease, and chronic kidney disease. Our study included 1,034 DR patients, of whom 438 (42.36%) died. The mean age of all patients was 63.26 (0.51) years old, with a median follow-up time of 75.00 months. Higher magnesium intake was associated with lower all-cause mortality risk (HR=0.58, 95% CI: 0.38-0.88) in DR patients. The association remained for those aged <65 years (HR=0.35, 95% CI: 0.15-0.81), male patients (HR=0.48, 95% CI: 0.27-0.84), patients without chronic kidney disease (HR=0.43, 95% CI: 0.23-0.82), and patients with a history of cardiovascular disease (HR=0.63, 95% CI: 0.39-1.02). DR patients with adequate magnesium intake exhibited a lower incidence of all-cause mortality. Further studies are needed to validate our findings and explore the optimal strategy for magnesium supplementation in DR patients.

A physiological concentration of magnesium (Mg) is essential for optimal skeletal muscle function. Indeed, Mg plays a crucial role during the differentiation process (myogenesis), in muscle fiber composition, muscle contraction and performance. This narrative review describes in detail the relevance of Mg in skeletal muscle, highlighting the importance of adequate Mg intake to ensure optimal skeletal muscle cell function and performance in individuals of all ages.

Magnesium is one of the recommended treatments for calcium stone formers (CSFs) with hyperoxaluria. In this study, we compared the effect of magnesium oxide (MgO) or magnesium citrate (MgCit) with placebo on 24-hour urine (24-U) metabolites and the calcium oxalate supersaturation index (CaOx SS). In a randomized, double-blind, placebo-controlled clinical trial, 90 CSFs with idiopathic hyperoxaluria were recruited from a tertiary stone prevention clinic. Patients were randomly assigned into three groups: 120 mg MgO, 120 mg MgCit or placebo (supplements were taken three times per day, with meals). Finally, 76 patients were included in the final analysis. Analyses of 24-U were performed at baseline and after eight weeks. Study outcomes included changes in 24-U oxalate, magnesium, citrate, and CaOx SS. Dietary factors were controlled by 24-hour food recalls. Repeated measure ANOVA was used to compare the results. After the intervention, both MgO and MgCit supplements decreased 24-U oxalate excretion (-8.13±16.45 in the MgO group and -16.99±18.02 in the MgCit group) and CaOx SS compared to the placebo, with the effects of MgCit reaching statistical significance (p=0.011 and p=0.010, respectively). An increasing trend was observed for 24-U magnesium and citrate excretion without significant differences among groups. Interestingly, MgCit exhibited a significantly greater inhibitory effect on 24-U oxalate in patients with normal urine magnesium levels (p=0.021). Clinically, both MgO and MgCit reduced 24-U oxalate and CaOx SS compared to placebo. However, MgCit demonstrated a greater effect, especially in patients with normal urine magnesium levels.

Liver fibrosis (LF) is a common complication of type 2 diabetes mellitus (T2DM). Studies have found that dietary magnesium (Mg), as an antioxidant nutrient, may be related to the occurrence and development of liver diseases. The aim of the present study was to evaluate the association between dietary Mg and the risk of LF in T2DM patients. In this cross-sectional study, data of T2DM patients, aged ≥18 years, were extracted from the National Health and Nutrition Examination Survey (NHANES 2017-2018). Dietary Mg intake information was obtained by 24-hour dietary recall review. Covariates included sociodemographic information, lifestyle, laboratory data, disease history and medication history, extracted from the database. Weighted univariable and multivariable logistic regression models were used to assess the association between dietary Mg intake and LF among T2DM patients, with odds ratio (OR) and 95% confidence interval (CI). Subgroup analyses based on patients with or without a history of hepatic steatosis were further assessed. A total of 945 participants were finally included, of whom 219 (23.17%) had LF. After adjusting for covariates, a high level of dietary Mg intake (OR=0.40, 95% CI: 0.17-0.93) was associated with lower odds of LF in T2DM patients, especially in patients with a history of hepatic steatosis (OR=0.39, 95% CI: 0.17-0.87). High dietary Mg intake has potential benefits in maintaining a healthy liver in T2DM patients. Sufficient Mg-rich foods and Mg supplementation may be beneficial for liver health management among T2DM patients. Further cohort studies are needed to confirm these findings.

The association between short-term changes in serum magnesium level and risk of in-hospital mortality was investigated in patients with acute myocardial infarction (AMI). In this retrospective cohort study, data of 2,716 patients with AMI were extracted from the Medical Information Mart for Intensive Care (MIMIC-III and MIMIC-IV) database for 2001-2012. Univariate and multivariate Cox proportional hazards models were used to explore the association between serum magnesium level and short-term change and in-hospital mortality in patients with AMI. In addition, subgroups according to age, gender, Sequential Organ Failure Assessment (SOFA) score, and Simplified Acute Physiology Score (SAPS-II) were also analysed. In total, 504 (18.6%) patients died in hospital. After adjusting for covariates, all AMI patients with high magnesium levels at ICU admission (HR=1.03, 95% CI: 0.83-1.27) or 48 hours after ICU admission (all p<0.05), or those demonstrating a change in magnesium level within the first 48 hours of ICU stay (all p<0.05) were shown to have a high risk of in-hospital mortality. Moreover, this correlation was retained irrespective of age, gender, SOFA score, and SAPS-II (all p<0.05). Serum magnesium levels at different time points after ICU admission and change in serum magnesium level during the first 48 hours were associated with in-hospital mortality in patients with AMI, indicating that clinical attention should be paid to short-term changes in serum magnesium levels regarding treatment adjustment, which may further reduce the risk of mortality.

Pathogenic mechanisms implicated in the development of Parkinson disease (PD) are multifaceted and include alpha synuclein aggregation, oxidative stress due to generation of reactive oxygen species (ROS), mitochondrial dysfunction, apoptosis, imbalance of trace elements as well as endoplasmic reticulum stress, and inflammation. Alteration in the homeostasis of bivalent cations, such as iron, magnesium and calcium, has been implicated in the pathogenesis of PD. Low levels of magnesium have been associated with accelerated dopaminergic cell loss in animal PD models, and magnesium has been shown to have a neuroprotective effect in PD models. Evidence of a low magnesium level in the brain of PD individuals, with a low magnesium level in the diet, increasing the risk of PD, further strengthens the role of magnesium deficiency in the pathogenesis of PD. The presence of low-level magnesium in brain tissue and high level in CSF and serum support the possibility of dysfunctional magnesium transporters in PD. Indeed, variants in magnesium transport channels, such as TRPM7 and SLC41A1, have been recently detected in PD individuals. Magnesium, being an NMDA antagonist, could also have a therapeutic role in levodopa-induced dyskinesia. There are no clinical studies indicating a neuroprotective role of magnesium in PD, however, the Mediterranean diet and variants of the diet have been associated with a lower risk of PD, which may be due to the magnesium-rich constituents of the diet. Further clinical trials encompassing therapeutic models to optimize channel function, coupled with a high magnesium diet, may pave the way for promising neuroprotective intervention for PD.

To evaluate the analgesic effects of intravenous magnesium in patients undergoing thoracic surgery. Randomised clinical trials (RCTs) were systematically identified from MEDLINE, EMBASE, Google Scholar and the Cochrane Library from inception to May 1st, 2023. The primary outcome was the effect of intravenous magnesium on the severity of postoperative pain at 24 hours following surgery, while the secondary outcomes included association between intravenous magnesium and pain severity at other time points, morphine consumption, and haemodynamic changes. Meta-analysis of seven RCTs published between 2007 and 2019, involving 549 adults, showed no correlation between magnesium and pain scores at 1-4 (standardized mean difference [SMD]=-0.06; p=0.58), 8-12 (SMD=-0.09; p=0.58), 24 (SMD=-0.16; p=0.42), and 48 (SMD=-0.27; p=0.09) hours post-surgery. Perioperative magnesium resulted in lower equivalent morphine consumption at 24 hours post-surgery (mean difference [MD]=-25.22 mg; p=0.04) and no effect at 48 hours (MD=-4.46 mg; p=0.19). Magnesium decreased heart rate (MD = -5.31 beats/min; p=0.0002) after tracheal intubation or after surgery, but had no effect on postoperative blood pressure (MD=-6.25 mmHg; p=0.11). There was a significantly higher concentration of magnesium in the magnesium group compared with that in the placebo group (MD = 0.91 mg/dL; p<0.00001). This meta-analysis provides evidence supporting perioperative magnesium as an analgesic adjuvant at 24 hours following thoracic surgery, but no opioid-sparing effect at 48 hours post-surgery. The severity of postoperative pain did not significantly differ between any of the postoperative time points, irrespective of magnesium. Further research on perioperative magnesium in various surgical settings is needed.

Since the start of the COVID-19 pandemic, it has become increasingly clear that the disease can have relevant multisystemic and long-term effects, and several studies have attempted to identify key determinants of the disease course. Here we discuss recent evidence suggesting that, in long COVID patients, combined magnesium and vitamin D deficiencies associate with a higher number of clinical manifestations, as compared to patients with normal levels of both nutrients. We highlight the potential synergistic effects of these deficiencies and propose that future studies should explore a causal link with the risk of developing long COVID. Most importantly, randomized clinical trials are needed to determine if magnesium and vitamin D supplementation can improve long COVID symptoms, providing a safe and affordable support therapy to the benefit of patients and society.

Dietary magnesium deficiency increases osteoclastic bone resorption and decreases osteoblastic bone formation. Increased bone resorption due to dietary magnesium deficiency can be explained by increased expression of the receptor activator of nuclear factor kB ligand. However, the detailed mechanisms underlying decreased bone formation remain unclear. Thus, in the present study, to determine the mechanism underlying decreased bone formation induced by dietary magnesium deficiency, we investigated the effects of short-term dietary magnesium deficiency on the mRNA expression of genes related to bone formation in rats. Male Wistar rats were fed a control or magnesium-deficient diet for eight days. The mRNA expression level of Runx2, Sp7, Bglap, Alpl, Col1a1, Igf1, and Bmp2 in the femur was significantly lower in magnesium-deficient rats than in control rats. These results suggest that short-term dietary magnesium deficiency decreases the gene expression of insulin-like growth factor-1 and bone morphogenetic protein 2, which, in turn, decreases osteoblastic bone formation through the downregulation of osteoblastogenesis-related gene expression.

Clinical manifestations related to hypomagnesemia and/or deficiency of vitamin D are frequent in patients with an extended course of coronavirus disease-2019 (long COVID). To evaluate hypomagnesemia and hydroxyvitamin D deficiency in patients with long COVID. A total of 125 adults with a diagnosis of long COVID were enrolled in a cross-sectional study. Participants were allocated into a risk (hypomagnesemia and hydroxyvitamin D deficiency) or control (serum magnesium and hydroxyvitamin D within normal ranges) group. Hypomagnesemia and 25-hydroxyvitamin D deficiency were defined based on serum level ≤1.8 mg/dL and <30 ng/mL, respectively. The number of clinical manifestations of long COVID were significantly higher in the risk compared to the control group. Fatigue, memory loss, attention disorders, joint pain, anxiety, sleep disorders, myalgia, and depression, all of which are related to hypomagnesemia and/or 25-hydroxyvitamin D deficiency, were among the 10 most frequent manifestations in the risk group. The adjusted odds ratio for the association between hypomagnesemia and hydroxyvitamin D deficiency during long COVID was 3.1; 95% CI 2.3-12.4, p=0.005. Our results show that patients suffering with long COVID had a deficiency in magnesium and 25-hydroxyvitamin D which correlated with the number of associated clinical manifestations.

This study aimed to investigate the association between serum magnesium trajectory and risk of in-hospital mortality in intensive care unit (ICU) patients with sepsis. Adult sepsis patients who had complete data on serum magnesium at ICU admission (at 0, 12, 24, 36 and 48 hours after ICU admission) based the 2012-2019 Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included in this retrospective cohort study. Serum magnesium trajectories were identified using K-means cluster analysis. The multivariable Cox proportional-hazards model was used to evaluate the association between magnesium level at different time points or magnesium trajectory and in-hospital mortality. A total of 2,270 patients with sepsis were enrolled, and in-hospital mortality occurred in 716 (31.54%). Three trajectories were identified: a high-level declining trajectory, normal-level stable trajectory, and low-level rising trajectory. Among the magnesium levels at different time points, a higher serum magnesium level only at ICU admission (0h) (hazard ratio [HR] = 1.13, 95% confidence interval [CI]: 1.03-1.23) was associated with an increased risk of in-hospital mortality. Compared with the normal-level stable trajectory group, patients in the low-level rising trajectory group (HR = 0.82, 95%CI: 0.70-0.97) had a reduced risk of in-hospital mortality, but no association with in-hospital mortality was found in patients in the high-level declining trajectory group (p=0.812). Conclusion: Sepsis patients with a low-level, rising magnesium trajectory may have a reduced risk of in-hospital mortality.

Low magnesium (Mg) intake increases the risk of various diseases such as anxiety disorder, depression, and diabetes. However, a reliable biomarker of mild Mg deficiency due to low Mg intake has not yet been identified. We speculate that metabolomics will be effective for biomarker discovery because Mg can affect various metabolic processes in the body. In the present study, we evaluated whether mild Mg deficiency affects growth, behaviour, and plasma and urinary metabolomes in rats. Mg levels in plasma and the femur, and urinary Mg excretion decreased by consuming a mildly low Mg diet, whereas body weight and food intake were not affected. Also, anxiety- and depression-like behaviours were not affected by Mg deficiency. These results indicate that the negative effects observed here are milder than those for severe Mg deficiency, as previously reported. Of the 93 annotated metabolites in plasma, only glycylglycine was moderately affected. Of the 122 annotated metabolites in urine, 29 were affected. A marked decrease in urinary excretion of some organic acids of the tricarboxylic acid cycle, particularly citric acid, was noticed. This study identifies urinary metabolites that may be useful biomarkers of mild Mg deficiency.

Individuals with long-COVID exhibit a higher frequency of hypomagnesemia, vitamin D deficiency, and depression. Objective. To evaluate the efficacy and safety of oral supplementation with magnesium chloride plus vitamin D in alleviating depressive symptoms related to long-COVID. A total of 60 subjects, aged 52.8±12.6 years, with a diagnosis of hypomagnesemia, vitamin D deficiency, and mild-to-moderate depression (MMD) related to long-COVID, were enrolled in an open-label randomized, controlled clinical trial. Participants were randomly allocated into an intervention group (n=30) that received magnesium chloride (1300 mg) plus vitamin D (4000 IU), or a control group (n=30) that received vitamin D (4000 IU), for four months. Using the Beck Depression Inventory (BDI), diagnosis of MMD was established based on a score of ≥11<30. The primary trial endpoint was improvement in depressive symptoms (BDI <11). Mild adverse events that did not require withdrawal from intervention were documented in six (20.0%) and three (10%) individuals of the intervention and control group, respectively. By comparing baseline vs. final measurements, the BDI score was significantly reduced in individuals in the intervention (28.8±3.7 to 9.2±7.5, p<0.01) and control (28.4±3.8 to 21.6±9.1, p<0.05) group. A total of 22 (73.2%) subjects in the intervention group and 10 (34.5%) in the control group reached a BDI <11, p=0.006. Our results show that, among patients with hypomagnesemia and vitamin D deficiency, combined oral supplementation with magnesium plus vitamin D is effective and safe in alleviating MMD related to long-COVID.

Impulsive behaviours affect patients with major depressive disorder (MDD) and bipolar disorder (BP), increasing suicide risk and mood instability. Ketamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist, has been reported to promote fast-acting antidepressive and antisuicidal effects. Magnesium administered contemporarily with low-dose NMDA antagonists has been shown to cause a reduction in anxiety-related and depressive-like behaviours. This observational study investigated the possible association between magnesium levels and impulsivity, measured using the Barratt Impulsiveness Scale (BIS-11), during ketamine treatment. Forty-nine inpatients with treatment-resistant mood disorders were involved in the study. The study therapeutic intervention was based on the administration of eight ketamine intravenous infusions over four weeks. The BIS-11 and magnesium levels were assessed for every subject before the first, third, fifth and seventh ketamine infusion and one week after the last infusion. The concentration of magnesium ions during the ketamine treatment was not associated with BIS-11 changes. The study does not provide evidence for a relationship between magnesium concentration and impulsivity, measured using the BIS-11, during ketamine treatment.

Although intraoperative magnesium sulphate administration has various advantages, its influence on the occurrence of postoperative acute kidney injury (AKI) remains unclear, particularly in patients undergoing robot-assisted radical prostatectomy (RARP). The steep Trendelenburg position and a high intra-abdominal pressure can render patients susceptible to AKI after surgery. This study aimed to evaluate the effects of intraoperative magnesium sulphate administration on postoperative AKI in patients who underwent RARP. This retrospective study used a propensity score-matched analysis to evaluate the medical records of patients who underwent RARP between May 2013 and December 2021 in a single institution. In total, 3,239 cases were reviewed. After propensity score matching, 456 patients were each included in the magnesium and control groups. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for postoperative AKI, as defined by the Kidney Disease Improving Global Outcomes criteria, within seven days after surgery. The incidence of postoperative AKI did not differ significantly between the magnesium and control groups (30.7% versus 31.4%). The univariate logistic regression analysis revealed that intraoperative magnesium sulphate administration was not associated with AKI after RARP (p=0.83). In the multivariate analysis, body mass index (odds ratio [OR], 1.069; p=0.018) and duration of surgery (OR, 1.005; p=0.027) were independent risk factors, while total intravenous anaesthesia (OR, 0.448; p=0.005) and intraoperative fluid replacement (OR, 0.856; p=0.012) were protective factors for postoperative AKI. Intraoperative magnesium sulphate administration had no significant effect on the occurrence of postoperative AKI in patients undergoing RARP.

This study aimed to explore the association between serum vitamin D and/or dietary magnesium intake levels and severe hepatic steatosis. This cross-sectional study collected data from 2,874 individuals in the NHNAES database between 2017 and 2018. Variables were subjected to weighted univariate logistic regression analysis, and variables with p<0.05 were selected for weighted multivariate logistic regression analysis. The stepwise backward method was then used, and variables with p<0.05 in the weighted multivariate logistic model were retained as confounding factors. Univariable and multivariable logistic regression models were applied to explore the effect of magnesium intake and/or vitamin D level on the risk of hepatic steatosis in overweight and obese individuals. Subgroup analysis was stratified by age, gender, BMI, and complications. The respective odds ratio (OR) and confidence interval (CI) were calculated. The risk of severe hepatic steatosis in overweight and obese individuals was increased in those with deficient serum vitamin D levels (OR: 1.71, 95% CI: 1.13-2.57). No significant correlation between dietary magnesium intake level and severe hepatic steatosis was observed in overweight and obese individuals (all p>0.05). However, an increased risk of severe hepatic steatosis in overweight and obese individuals was found in those with deficient dietary magnesium intake and deficient serum vitamin D compared to those with sufficient serum vitamin D (OR: 1.86, 95% CI: 1.20-2.89). Deficient magnesium intake in overweight and obese patients with low serum vitamin D levels may increase the risk of severe hepatic steatosis, however, future studies are required to verify our findings.